The Claims Clerk is responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.
- Work claims files to ensure the appropriate eligibility and provider records are matched to the claim
- Consistently meet established productivity, schedule adherence, and quality standards
- Analyze and identify trends and provide reports as necessary
- Conduct data entry and re-work; analyzes and identifies trends and provides reports as necessary.
- Provide general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
- Identify more complicated claims and refer them to Senior Claim Processor or Supervisor
- Authorize the appropriate payment or refers claims to investigators for further review.
- Updates and maintains claims tracking database
- Recognize claims by determining claim type – HCFA, Hospital, UB, and/or RX
- Calculate other insurance and re-pricing benefits
- Experience with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Basic understanding of healthcare claims including ICD-9 and CPT codes
- 1+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
- High school diploma / GED (or higher)
- 2+ years of data entry experience
Vacancy Type: Full Time
Job Location: Dallas, TX, US
Application Deadline: N/A